阿德福韦酯致低磷性骨软化症六例分析  

Six cases of hypophosphataemic osteomalacia induced by adefovir dipivoxil

作　　者：张楠[1] 邵明玮[1] 黄爱[1] 栗夏莲[1] 秦贵军[1] 汪丽娟[1] 

机构地区：[1]郑州大学第一附属医院内分泌科,郑州450052

出　　处：《中华内分泌代谢杂志》2013年第5期414-416,共3页Chinese Journal of Endocrinology and Metabolism

摘　　要：分析近14个月确诊的6例阿德福韦酯（ADV）相关性肾病患者的临床资料及诊治经过。结果显示，服用ADV 10~20 mg/d，2~3年后出现全身多处骨关节疼痛。均有低磷、低尿酸血症，成骨指标明显升高，1例血肌酐升高，5例有低血钾、肾性糖尿，4例有蛋白尿，影像学检查提示骨质疏松、骨软化、假性骨折。确诊后停用ADV，经补磷及活性D3后，3~6周疼痛缓解,1~2.5个月血尿酸正常，1~2个月肾性糖尿及蛋白尿消失。提示ADV应用超过2年，应注意其引起的肾损害，定期监测肾功能、电解质、尿常规可早期发现肾损害。血尿酸降低是一个较好的诊疗观察指标。An analysis of clinical data was performed in 6 patients diagnosed as adefovir dipivoxil （ADV）-induced nephropathy in recent 14 months. The results showed that all of six patients suffered from pain over multiple joints after taking ADV 10-20 mg/d for 2-3 years, along with hypophosphatemia, hypouricemia, and raised osteogenesis index. One case had increased serum creatinine, 5 cases had hypokalemia, renal glycosuria, and 4 cases had albuminuria. Imageological examination showed osteoporosis, osteomalacia, and pseudo fracture. After discontinuance of ADV treatment, joint pain was obviously relieved within 3-6 weeks, blood uric acid level returned to normal within 1-2.5 months, and renal glycosuria and albuminuria disappeared by 1-2 months. The results suggest that after taking ADV for more than two years, attention should be paid to the nephropathy induced by ADV and regular monitoring of renal function, blood electrolyte, and urine should be mandatory. Hypouricemia is a reliable index of diagnosis and treatment in this event.

关 键 词：阿德福韦酯 肾损害 范可尼综合征 低磷性骨软化症 

分 类 号：R512.62[医药卫生—内科学]